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Big Pharma Controls Your Doctor’s Brain

Two themes this week. First, on the very same morning I sent out last week’s Health Tip expressing my dismay at an Annals of Internal Medicine article and editorial advising physicians to discourage patients from using multiple vitamins a new study from Germany showed that vitamin D deficiency was strongly linked to fatal heart attacks and strokes.

Typical multivitamins, like Centrum Silver or One-A-Day, contain small amounts of vitamins, called “minimum wage” vitamins by nutritionists, but the minimal amount of vitamin D in each of them (800 IU or 200% of the minimal daily requirement in Centrum Silver, 1,000 IU or 250% in One-A-Day Women’s 50+ Healthy Advantage) is, according to the study, enough to confer some heart protection. The article shows that vitamin D deficiency increases risk. At WholeHealth Chicago, we measure vitamin D levels and discover that virtually everyone not taking supplemental D is deficient, some with amazingly low levels.

My day didn’t get better when I read a brief report in this week’s JAMA (Journal of the American Medical Association).

Doctors and Big Pharma under the microscope
The relationship between physicians and Big Pharma is receiving ever more scrutiny. In this article, researchers from Columbia University wanted to explore the questionable relationship between Big Pharma and an industry you’ve probably never heard of called Medical Communication Companies (MCCs). You’ll likely recognize the biggest MCC players–familiar internet names like Medscape and webMD–but there are numerous others, accessible only by physicians, with distinguished-sounding names like Postgraduate Institute for Medicine, Network for Continuing Medical Education, and Institute for Medical Education and Research.

By way of background, you already know that physicians do try to keep current with the latest developments in medicine. At one time we achieved this by subscribing to an assortment of print journals and attending meetings with other physicians in our field. And while the journals were replete with Big Pharma ads and the meetings always had one convention hall filled with Big Pharma displays, at least the articles you’d read and the lectures you’d attend were free from commercial taint.

As a physician, you also need to prove to your local state licensing board that you’re keeping abreast in medicine by accumulating Continuing Medical Education credits (CMEs) each year. With the journals, you’d complete a quiz on the back page, mail it in, and receive a certificate stating the number of hours you’d earned by reading that issue. At medical meetings, you’d sign in at the beginning of every lecture and a couple of weeks later receive a certificate from the meeting’s sponsor, almost always a not-for-profit medical group (like the AMA or Chicago Medical Society) or a medical school.

Although educational programs like these are still available, with the decline of paper and ink, rising travel costs, and the financial strain on a doctor leaving her practice for a week or so, there’s far more reliance today on online medical education to accumulate CMEs.

Which raises a serious problem.

For-profit continuing medical education
According to the JAMA report, the bulk of CME courses are being offered under the auspices of MCCs, a majority of which are for-profit entities receiving most of their funding from (who would have guessed it?) Big Pharma.

What kind of money do these MCCs actually receive? Well, the total grant money from the top 14 pharmaceutical companies (for both education and research) in 2010 was $657 million. Of this largesse, 26% ($170 million) went to MCCs specifically to “educate and communicate with” physicians. Smaller grants were distributed to academic medical centers, disease-targeted advocacy groups, and professional medical organizations, like the AMA.

Medscape/WebMD, a single company, is a mega-source of physician CME credits. (The WebMD portion provides health information to the general public that virtually always recommends using a Big Pharma product to cure what ails you.) It received $20 million in Big Pharma grants. So-called disease-targeted advocacy groups are usually a cover for Big Pharma commercials. Google “fibromyalgia” and two of the three top results are sponsored by Big Pharma. Now try this with virtually any medical condition.

With physician education and CME accreditation moving online, the bulk of CME courses are now under the auspices of MCCs, which in turn are funded by Big Pharma. What this generally means is that an innocent-sounding useful course called “Advances in Diabetes Management” may mysteriously have as the correct quiz answers (the answers that will earn you CME credit) those that promote pharmaceuticals.

Interestingly, the CME cannot name a specific drug brand because that would be a “conflict of interest.” But mentioning the same drug’s chemical name is completely allowable.

Your doctor’s class on migraines, sponsored by…
For example, I might take a CME course on migraine headaches, sponsored by Zogenix, maker of a new migraine treatment called Sumavel. Because I’m required to enter so much personal and practice data just to enroll as a Medscape physician, the MCC can collect this information, share it with Big Pharma, and sell it to Little Pharma–fledgling pharmaceutical companies (there are dozens) itching to get their hands on physician data.

The MCC will also track my interaction at its website, scrutinizing the topics I’m seeking information about so they can send some targeted marketing in my direction. If I look up migraines on Medscape, I’m bound to start receiving “informative articles” and, if they do develop a CME course, I’ll be reminded to sign up.

Big Pharma can also buy data from Walgreen’s to track my prescribing behavior and see if these MCC investments are actually paying off. The CME course–written by medical writers, almost never by physicians–will allegedly teach me something about migraines, but mainly about drugs, primarily about the “positive studies” submitted to the FDA (hiding away the negative ones) that merited FDA approval. There will probably be some subtle language that trashes the drug’s competitor, such as a list of side effects.

I’ll then get CME credit, which I can use toward renewing my license. For the following few weeks, I’ll receive an increased number of articles online updating me on the latest advances in migraines (with emphasis on drug treatment) with lot of little Sumavel icons across the top. I may even get a visit from my Sumavel rep. (You’ll recognize this tracking behavior if you’ve ever shopped online and subsequently started seeing copious ads for precisely what you were shopping for.)

Is this all worthwhile to the Pharma company? You bet it is. Sumavel may or may not relieve your migraine, but it costs $125 a dose, a single prescription providing six doses, or $750 a pop.

Let me end this cheery health tip on Big Pharma mind control with a long-forgotten science fiction story I once read. It had the following very spooky premise: Silicon (sand), the very heart of every computer on the planet, was actually a living substance and the alien force that had animated silicon was waiting until every human on the planet had access to a computer. Then, in a single moment, all our brains would collectively be controlled by the silicon in the very computer you’re now using to read this Health Tip.

But that’s the stuff of science fiction. You don’t have to worry. It’s only your doctor whose brain is being controlled. All you need to do to protect yourself from her is to stay…very healthy.

Another reminder that we must always take ultimate responsibility for our health and at all times keep Caveat Emptor engaged. New Years greetings to all of you back in Chicago where I made my grand entrance 72 years ago at Swedish Covenant Hospital.

As a health coach I’ve had numerous people come to me saying their doctors told them their ailment is just something because of their age they have to deal with. Three weeks later after taking vitamin d or b-12, their essential tremors or winter blues are gone and they wonder why the doctor said there were no options!

This is the sort of stuff that really gets me out there trying to encourage people!

Oh dear. How sad for all the innocent patients and unsuspecting doctors out there. I guess it all comes down to money and greed. Thanks for this amazing write-up / keen research. Loved that science fiction ending too… from our very talented writer-doctor-detective.

Thanks, Dr. Edelberg, for your clarity and courage to write this article. My heart goes out to you, in that you have to deal with this form of predatory capitalism so often. We do, too, but we have more freedom and choice.

Thanks for being a leader in the integrative medical field. I am a former client and always appreciated your time, expertise, wisdom and humor. I teach an integrative medical course for consumers at DePaul (a science elective) called Energy and Health. I have these adult professional students grapple with these health and medical issues, and they use critical thinking to bust through the medical industry indoctrination.

Most then make some dramatic health and wellness changes, begin to own their bodies and choices, and finally begin to truly invest in their health.

The medical industry/Big Pharma looks powerful, but it’s actually a dying dinosaur. It’s not based on truth and true health. The science is manipulated. Many of us are searching for the source cause answers, and finding them in nature and healthy habit changes. Health is wealth.

It’s about time that someone has exposed the relationship between most physicians and big pharma. Some of us have known about this for years. Thanks, Dr. Edelberg, for having the guts to expose what medicine in the US is really like. This is why medicine in the US ranks roughly 14th or worse in the world depending on what’s being looked at. Disgusting and frightening. This is why I’m a client of Whole Health Chicago.

Usually I keep my mouth shut on the topic of industry (pharma and medical device companies) when you write about it, but this time I cannot keep quiet due to your gross misrepresentation of the issue. I work for two non-profit medical associations that provide CME sessions during their annual conventions. As you know, physicians attend these conferences to keep up with the CME/Maintenance of Certification requirements.

My job is to secure continuing medical education grants from pharmaceutical and medical device companies for the CME sessions. I can assure you that any accredited provider of continuing medical education must adhere to strict guidelines from the Accreditation Council of Continuing Medical Education (ACCME) called Standards of Commercial Support (SCS) to insure independence. According to the SCS, industry is not allowed to control content or recommend speakers for CME sessions. If a provider does not adhere to these guidelines, then they lose their licensing to provide CME (at a meeting or through medical journals like JAMA) to their physician members.

In addition, in August of 2013 the Sunshine Act went into effect. This law requires that industry report to the government any monetary interaction with a physician above $10.

These guidelines are so strict that funding of CME sessions from industry is becoming harder and harder to obtain because no company or medical association wants to be considered non-compliant and have that perception in the public. I can assure you that Continuing Medical Education is free from the persuasion of industry. Why do you think industry is moving more towards direct to consumer advertising – so that they can influence your patients to come to your office and ask for a prescription to treat their ailment. Industry knows that they no longer can reach the physician. Heck, they cannot even give out a pen at a convention with a drug name on it because that might be considered influencing the doctor.

Perhaps you should become more familiar with both the ACCME SCS guidelines and the Sunshine Act before writing an article like this and needlessly scaring the public. Speaking as a patient now, I want industry to support these CME sessions because without their support the CME sessions or journal articles would not happen as non-profit associations would not be able to fund meetings on their own. I want my doctors, including you, would not to be up-to-date on the latest treatments for my diseases.

Hi Linda
The concern I expressed in the piece did not just pop into my head. Take a look at the article in JAMA referred to in the first paragraph as well as the accompanying editorial.
As a physician, I am very uncomfortable with the pharmaceutical industry being involved with the CMEs needed for relicensure and have seen plenty of evidence of their biased input. Several years ago, I gave industry sponsored CME talks on fibromyalgia. I was given a set of slides from a “non-profit” medical communication company (MCC) and when I pointed out factual errors in the slides was told these absolutely could not be changed and that they had been approved “by our lawyers.” When I offered to include my own slides (used for medical students), the offer was flatly denied. I responded that their CME was deliberately dumbing down the intended physician audience in order to promote a product via misinformation.
Sorry, but I must disagree with you on this

I’m sorry to hear about your experience with your CME talk. That MCC is definitely not adhering to the ACCME Standards of Commercial Support and should be reported to ACCME.

MCC’s are different than non-profit medical associations and sometimes a little shady to deal with because they are hired by industry. However, if you are speaking directly on behalf of a medical association most will have a program committee comprised of physician members that develop the symposia and a CME staff to review slides to make sure they are not commercially biased. Once our program is developed I blindly submit grant requests to industry. Several pharmaceutical companies will outright reject the grant request if a speaker name is listed because they don’t want to appear that they requested the speaker.
I will be sure to read the article.

When you sign up to receive Health Tips, you can look forward to Dr. Edelberg’s smart and very current observations arriving in your in-box weekly. They’re packed with helpful information and are often slightly irreverent. One of the most common responses to the tips is “I wish my doctor talked to me like this!”

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